Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA.
Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Irving Medical Center, New York, New York, USA.
Prenat Diagn. 2024 Sep;44(10):1225-1230. doi: 10.1002/pd.6586. Epub 2024 May 9.
Fetal head and neck masses can result in critical airway obstruction. Our study aimed to evaluate prenatal factors associated with the decision for a definitive airway, including ex-utero intrapartum treatment (EXIT), at birth among at-risk fetuses.
A single-institution retrospective review evaluated all fetal head and neck masses prenatally diagnosed from 2005 to 2023. The primary outcome was the decision for a definitive airway at birth, including intubation, tracheostomy, or EXIT.
Thirty four patients were included, with 23 deliveries occurring at our institution. 8/23 (35%) patients received a definitive airway at birth, six underwent an EXIT procedure, and two required intubation only. Patients who received a definitive airway had higher rates of polyhydramnios (50% vs. 7%, p = 0.03), tracheal narrowing on ultrasound (US) (50% vs. 0%, p = 0.01), tracheal displacement on US (63% vs. 0%, p < 0.01), abnormal fetal breathing on US (50% vs. 0%, p = 0.01), tracheal narrowing or displacement on magnetic resonance imaging (MRI) (75% vs. 7%, p < 0.01), and larger mass maximum diameter (7.9 vs. 4.3 cm, p = 0.02). In our series, 100% of patients with polyhydramnios, tracheal narrowing or displacement on either US or MRI, and abnormal fetal breathing on US received a definitive airway at birth.
Prenatal findings of tracheal narrowing or displacement, polyhydramnios, and abnormal fetal breathing are strongly associated with the decision for a definitive airway at birth and warrant mobilization of appropriate resources.
胎儿头颈部肿块可导致严重气道梗阻。我们的研究旨在评估与出生时高危胎儿的明确气道决策相关的产前因素，包括子宫外产时治疗（EXIT）。
单中心回顾性研究评估了 2005 年至 2023 年间产前诊断的所有胎儿头颈部肿块。主要结局是出生时明确气道的决策，包括插管、气管切开术或 EXIT。
共纳入 34 例患者，其中 23 例在我院分娩。23 例分娩中有 8 例（35%）患者在出生时行明确气道处理，6 例行 EXIT 手术，2 例仅需插管。行明确气道处理的患者羊水过多发生率较高（50% vs. 7%，p=0.03），超声（US）检查发现气管狭窄（50% vs. 0%，p=0.01）、气管移位（63% vs. 0%，p<0.01）、US 检查发现胎儿呼吸异常（50% vs. 0%，p=0.01）、MRI 检查发现气管狭窄或移位（75% vs. 7%，p<0.01）及肿块最大直径较大（7.9 vs. 4.3cm，p=0.02）的比例较高。在本系列中，100%有羊水过多、US 或 MRI 检查发现气管狭窄或移位以及 US 检查发现胎儿呼吸异常的患者在出生时行明确气道处理。
产前发现气管狭窄或移位、羊水过多和胎儿呼吸异常与出生时明确气道处理的决策密切相关，需要调动适当的资源。
